Skip to main content

Aetna is now a CVS Health Company

Director, Health Care Quality Management

Primary Location: San Diego, CA
Additional Locations: CA-San Diego
Apply
Description:
- Acts as an Advocate for, and supports, the business by serving as a quality champion through measuring and monitoring the quality and effectiveness of the care and service provided to our members.
- Leads and manages all aspects of Quality programs and projects that enable Aetna to measure, monitor, and improve the quality of the care and service provided to its members.
- Consults and/or works cross functionally to influence and promote change in order to continually deliver quality service to our internal and external customers.
- Responsible for coordinating, leading, and managing multiple functional areas/units including full accountability for business/financial results related to following as appropriate: HEDIS reporting, quality of care, accreditation activities and/or member satisfaction.

Fundamental Components:
- Assures compliance with all State and Federal quality regulations, Aetna quality standards, and National Committee for Quality Assurance (NCQA) standards.
- Ensures maintenance of accurate documentation for quality improvement activities such as HEDIS reporting, surveys, audits, peer reviews, etc.
- In conjunction with key business leaders, responsible for directing the activities of quality committees.
- Provides direction setting and leadership, with accountability for quality program(s), specialized audits, special reviews, projects and initiatives.
- Manages complex projects, people, and business priorities to achieve member satisfaction.
- Develops and implements quality improvement activities nationally and/or within an assigned region.
- Directs data collection for HEDIS and/or other quality reporting; identifies opportunities for improvement based on results.
- Influences all stakeholders to support key quality projects/programs to ensure positive solutions that deliver results.
- Consults with internal/external customers on solutions that impact Quality.
- Controls expenses while meeting operational, functional and service requirements.
- Recruits, develops, and motivates staff. Initiates and communicates a variety of personnel actions, including employment, termination, performance reviews, salary reviews, and disciplinary actions.

Background Experience:
- Previous experience that reflects a proven track record or proficiency in the competencies noted required.
- 2+ years of experience managing staff required.
- 5+ years of clinical and/or Managed Care experience in the healthcare industry and Quality Management required.
- Demonstrated verbal/written communication and computer skills required.
- Ability to work in a fast paced environment required.
- Demonstrated ability to plan, organize, and execute multiple functional business objectives required.
- Masters degree preferred.
- Registered Nurse (RN) licensure preferred.
- Certified Professional in Health Quality (CPHQ) or other certification a plus.


Additional Job Information:
Exceptional communications skills including ability to interact with a variety of external and internal audiences including senior management.

Required Skills:
Leadership - Collaborating for Results, Leadership - Creating a World Class Workforce, Leadership - Creating Accountability, Leadership - Developing and Executing Strategy, Leadership - Driving Strategic and Organizational Agility

Desired Skills:
Leadership - Creating a World Class Workforce, Leadership - Developing and Executing Strategy, Leadership - Driving Strategic and Organizational Agility

Functional Skills:
Management - Management - Health Care Delivery

Education:
Nursing - Registered Nurse

Potential Telework Position:
No

Percent of Travel Required:
10 - 25%

EEO Statement:
Aetna is an Equal Opportunity, Affirmative Action Employer

Benefit Eligibility:
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Candidate Privacy Information:
Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.

Click To Review Our Benefits (PDF)

Apply

Jobs for you

Recently Viewed Jobs

You do not have any recently viewed jobs

Your Saved Jobs

You do not have any saved jobs

Sign up for Job Alerts

Join our Talent Community

At Aetna, we are pioneering a total approach to health and wellness and we need talented candidates like you to join our team. Become a member of our talent community to be the first to know about career initiatives that match your skills and interests as they become available, in addition to details on upcoming events, networking opportunities, and news about Aetna.

Join Our Talent Community

Sign up to receive information about job openings that are tailored to your skills and interests. Plus, get the latest career news from Aetna.